To investigate the effects of hysteroscopic myomectomy on menstrual patterns in women with menorrhagia and on reproduction in infertile women, the authors followed up 108 women (average age, 37 years) who underwent this procedure. Seventy-two women had menorrhagia, and 36 were infertile for an average of 22 months. Four women with excessive bleeding were also infertile, and 29 infertile patients also had menorrhagia. Fifty-four women had undergone hysteroscopic myomectomy for pedunculated myoma; 30 women, for sessile myoma; and 24 women, for intramural myoma. In addition, 14 percent of the patients had more than one submucous lesion, and 14 percent had small intramural or subserosal myomas that did not deform the cavity. Eighty-two percent of patients were treated preoperatively with hormones.Intraoperative hemorrhage, controlled by uterine massage and intravenous methylergonovine maleate, was the only intraoperative complication. Operating times averaged 18 minutes for removal of pedunculated myomas, 22 minutes for removal of sessile myomas, and 32 minutes for removal of intramural myomas. The average distention fluid deficit for these three groups was 204, 278, and 335 ml, respectively. This represents a 78 percent longer operating time (P .001) and a 64 percent greater fluid deficit for intramural lesions compared with pedunculated lesions. Twenty-two percent of the women undergoing hysteroscopic myomectomy for pedunculated lesions required a second procedure, and 4 percent a needed third operation to complete removal of the myomas. Twenty-three percent of women with a sessile myoma underwent a second operation, and 3 percent underwent a third. There was a greater need for additional procedures in women with intramural myomas; 42 percent had a second operation, and 8 percent required a third.After an average follow-up period of 41 months, 22 percent of pedunculated and sessile myomas and 33 percent of intramural myomas had recurred. The overall 3-year cumulative myoma recurrence rate was 34 percent. All women experienced a significant postoperative decrease in blood loss assessment scores and measured blood serum levels as compared with preoperative measurements (P .01).Twenty of the 101 women treated for menorrhagia experienced a return of their symptoms, with an overall 3-year cumulative recurrence rate of 30 percent regardless of myoma type. Of the 40 infertile women, 15 became pregnant after treatment, resulting in an overall 3-year cumulative conception rate of 43 percent independent of myoma location.Obstet Gynecol 1999;94colon;341ndash;347
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